THE
GUIDE TO
NARCISSISTIC PERSONALITY
DISORDER
Dear Reader,
Imagine you say something that seems completely innocent, even lighthearted. “Hmm, next
time I put the Macintosh or Golden Delicious apples on my list for you, I’ll have to specify
large apples, not small,” you say with a laugh. But he doesn’t laugh. He scowls and begins a
defensive tirade about how what he did was right. Did you accuse? Blame? Put down? Of
course not!
You ask her, “The appointment is for 9:30?” and she replies, “No, it’s 9:00,” trying to
remain calm because she’d already given you two long explanations of how and why the time
changed in the space of three days. “How is it that you don’t listen to me?” She collapses
inside herself, thinking, “I can’t connect, he claims he loves me but he only remembers what
he says, and it’s usually wrong or twisted.”
Communication, interactions, and day-to-day living with narcissists or those with NPD is
anywhere from di cult and confusing to frustrating and damaging, and it is persistent. If you
are dealing with someone with NPD regularly—a partner, sibling, relative, friend, coworker,
or boss—life will be a continuing mess of often impossible and damaging behaviors and
interchanges. Typical and regular behaviors can include explosions and tirades of belittling,
blame, and verbal abuse, leaving you feeling helpless to know what or how to say the next
thing, feeling hurt and even damaged that this person does not seem to care about hearing
you, listening to you, or paying attention to you, your feelings, or your ideas.
Each situation is a little di erent, but in this book you will
nd great ideas and valuable
tools from our personal and professional experiences, along with heartfelt concern for you, so
you can gain the knowledge and understanding you need to make your life and your
relationships with narcissists or those with NPD better and more fulfilling.
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THE
GUIDE TO
NARCISSISTIC
PERSONALITY
DISORDER
Professional, reassuring advice for coping with the disorder—at work, at home, and in your
family
Cynthia Lechan Goodman, MEd and Barbara Leff, LCSW
To my beloved son Brett Jay Leff, whose loving understanding supported my work. —B.L.
To my loving husband Steve, who crosses the bridges to learn about my world and opens himself up to courageously learn about his
own world. —C.G.
Contents
The Top 10 Signs of Narcissistic Personality Disorder
Introduction
01 The Basics of Narcissistic Personality Disorder (NPD)
The History Behind the Disorder
Different Expressions of NPD
Millon’s Subtypes
Drug and Alcohol Abuse
Eating Disorders
Relationship Issues
02 Symptoms and Behaviors of NPD
Causes and Risk Factors
Warning Signs and Red Flags
Symptoms
When to See a Psychologist or Psychotherapist
Tests and Diagnosis
03 Comparing NPD to Other Personality Disorders
Varieties of Personality Disorders
Cluster B Personality Disorders
Histrionic Personality Disorder
Borderline Personality Disorder
Antisocial Personality Disorder
Dissociative Identity Disorder
Narcissism as the Basis for All Personality Disorders
Treatment of Cluster B Personality Disorders
04 Who Are the Narcissists?
Spotting Narcissistic Behaviors
Narcissists Are All Around Us
Important Common Risk Factors
The Role of Our Culture
Are Some People More Likely to Suffer from NPD?
Famous Narcissists
Can a Narcissist Lead a Normal Life?
Putting NPD into Perspective
05 What Can Lead to Narcissism?
Genetics or Psychobiology?
Child Abuse
Role of the Image
Mirroring
Denial of Feeling
Is Narcissism the Result of Pampering or Neglect?
Parenting and Self-Esteem
Lifestyle
Parents Who Are Narcissists
Minimizing Narcissistic Behaviors
06 Treatments for NPD
History of Treatment
Individual Therapy
Group Therapy
Cognitive Behavioral Therapy
Alternative Therapies
Medication to Control Symptoms
07 Additional Methods for Dealing with NPD
Lifestyle Changes and Self-Management
Alternative Ways to Help Yourself and the Person with NPD
Short-Term Goals for Both of You
Long-Term Goals for Both of You
Integrating Spirituality
Getting Help for Complications
08 What Happens Without Treatment?
Splitting as a Defense Mechanism
How Loved Ones Are Affected
When Patients Resist Diagnosis and Treatment
09 Asking for Help When Dealing with a Narcissist
When Should You Ask for Help?
Taking the First Steps
Whom Should You Ask?
Who Has the Right to Know (and Judge)?
How Can You Best Help Someone with NPD?
10 Exploring Myths and Lifestyles
A Little Narcissism Is Healthy … Right?
You Can’t Love Without Self-Love
NPD and the Workplace
Narcissism and Workaholics
Regaining Perspective
Replacing Lack of Empathy with Compassion
11 Tools and Coping Techniques
It’s Not Your Fault
Redefining Your Family
Venting, Sharing, and Getting Unstuck
Setting the Ground Rules
Understanding the Narcissist’s Past
Planning for Family Contact
Developing Realistic Expectations
Anchoring as a Coping Tool
12 Understanding Megalomania
The Role of Low Self-Esteem
NPD and Shame Issues
Real Strength Versus Covering for Weakness
Kohut’s Model
Cultural Considerations
13 Narcissism and Depression
The Depressive Narcissist
Dealing with Unfulfilled Needs
Depression as the Flipside of Adoration
Depression and the Loss of Narcissistic Supply
14 Changing Perspectives of the Relationships
Recognizing Reality—Yours and Theirs
Pitfalls and Problems with Love and Loving
Helping to Turn the Narcissist’s Focus to Others
Accepting Limitations
Enforcing Boundaries
Setting Mutual Goals for the Future
Perfectionism Versus Authenticity
Negative and Positive Thoughts and Feelings and Narcissism
Are Narcissists Evil?
15 The Digital Narcissist
Does Digital Technology Breed Narcissism?
Narcissism and Social Networking
Recognizing an Internet Narcissist
Narcissism and Cyberbullying
Avoiding the Trap of Internet Narcissism
16 If You Believe Someone Needs Help with NPD
When to Intervene
Expressing Your Concerns
Formal Interventions
Dealing with the Aftermath
Helping Yourself
Recognizing a Codependent of a Narcissist
17 Living Every Day with Someone Who Has NPD
Life with a Narcissistic Partner or Spouse
Life with a Narcissistic Parent
Life with a Narcissistic Sibling
Life with a Narcissistic Teen
Life with Narcissistic Relatives
Life with Narcissistic Friends
Life with a Narcissistic Coworker or Boss
18 Handling Interactions with a Narcissist
How to Speak to Someone with NPD
Stay Strong and Don’t Be Manipulated
Get What You Want from a Narcissist
Stop Being Victimized or Abused by Narcissism
Dealing with the Lies
Negotiating Skills in Handling Interactions with a Narcissist
Handling an Argument
19 Ongoing Controversies
NPD Versus Schizophrenia
NPD and Obsessive-Compulsive Disorder
Is NPD an Emotional Defensive or Offensive Strategy?
Is There a Gender Difference?
Healing, Changing, and Recognizing a Breakthrough
Elimination of the Diagnosis of NPD
20 Where Do You Go from Here?
Narcissism and the Concept of Self
Evolving Knowledge Base about NPD
Power of Love and Loving in Relationships and Narcissism
The Narcissism Epidemic
Will He Ever Change?
How Far I Have Come, and Why Has It Been Worth It?
Tooting Your Own Horn
Putting What You Learned and Know into Your Life
Establishing Healthy Habits and Boundaries
Appendix A: Symptoms Checklists
Appendix B: Additional Resources
Index
Acknowledgments
With love and thankfulness for Charlotte Goodman, the most quintessential mother-in-law
and best friend, for her understanding of the inevitable mistakes of parenting and for her
model of never-ending unlimited support, thoughtfulness, recognition, generosity, and love
for both her sons and her daughters-in-law.
With heartfelt gratitude to Ziva Avramovich, clinical and geriatric therapist, whose words
allow the possibilities for individuals and couples to find bridges of connections to each other,
building on learning, understanding, and love.
With love forever to my devoted family, for always being there with unlimited support for
me, for recognizing and encouraging my talents, and for instilling in me the respect,
compassion, and empathy for the uniqueness of others.
With the deepest level of thankfulness for the loving, supportive friendship of forty years of
Frank Cannavo, LCSW, whose natural compassion, empathy, patience, and appreciation of
others have helped to heal many.
With the utmost appreciation for my editor, Kate Powers, who has the gift of knowing, and
the skills to shape words to allow another person’s writing abilities and ideas to shine through
clearly, and simply, from the heart and soul.
With enduring gratitude to Rabbi Allan Tu s, who o ciated at my marriage and rededication
of marriage, for his spiritual leadership, and friendship that has supported the loving growth
and bonds of my family.
The Top 10 Signs of Narcissistic Personality Disorder
1. A need to feel superior to others; belittles and demeans others in this regard
2. Little or no empathy or compassion for the feelings, thoughts, or opinions of others
3. Always preoccupied with his own problems or thoughts
4. Shows little or no respect for authority and/or has little concern for morals
5. Extremely sensitive to any kind of criticism
6. Exploitative and vain toward all in order to provide a sense of power, exceptionalism, or
feeling better than others
7. Prone to explosive fits of rage
8. Extreme jealousy
9. Lacks the ability to admit when wrong
10. Distorts and lies to support her own interests, perceptions, and goals
Introduction
He seeks, is sought, he burns and he is burnt.
And how he kisses the deceitful fount;
and how he thrusts his arms to catch the neck
that’s pictured in the middle of the stream!
Yet never may he wreathe his arms around
that image of himself.
THIS PASSAGE IS FROM Ovid’s Metamorphoses: Echo and Narcissus, which tells the tale of a
beautiful young Greek boy who fell in love with his own re ection, leading to his own
destruction. This classic parable of the dangers of self-love gave us the terms “narcissist” and
“narcissism.” As you may have guessed, it was Sigmund Freud in the mid-1900s who actually
introduced these terms into the psychological texts. But since then a lot has been learned
about narcissism. Today, more than ever, there are still many myths and misunderstandings
about the emotional disorder. Questions are now on everyone’s mind about our friends,
neighbors, family, and adored and admired celebrities.
Is my husband or wife a narcissist?
Is narcissism really a personality disorder?
Is narcissism always a bad thing?
Isn’t a little narcissism necessary for success?
Aren’t all celebrities basically narcissistic?
What should we do about a potential narcissist at home, at work, or in the family?
These are just some of the questions and controversies this book will explore, along with
helpful tips and resources on how to identify the signs and symptoms of narcissistic
personality disorder (NPD), and how to deal with the e ects of narcissism in your personal
and professional relationships.
According to researchers at San Diego State University, we may be living with an “epidemic
of narcissism” in the youth of America. The researchers concluded that permissive parenting,
celebrity culture, and the Internet may have all contributed. ABC News 20/20 recently ran an
episode titled “The Rise of Narcissism in America.” In her book based on the San Diego State
study, psychologist Jean M. Twenge, PhD, wrote that there has been a 67 percent increase in
narcissism over the past two decades, and she estimated 10 percent of the overall population
suffers from narcissism as full-blown NPD.
This means it is likely that you may be loving, living with, or working with someone who
has some degree of NPD. That situation can be frustrating, unsettling, and even damaging to
relationships. But take comfort in the knowledge that you are not alone in this situation. This
book will give you all the information and tools you need to know where, when, how, and
why narcissism may be a ecting your life. And it will show you the many ways you can help
yourself and anyone you may know, love, or live with.
From Greek mythology to modern psychology, our understanding of narcissists and
narcissism has come a long way. For many years, narcissism was considered untreatable. But
over the course of the last four decades, mental health professionals have begun to identify
successful treatment procedures and management tools for narcissists and their families.
CHAPTER 1
The Basics of Narcissistic Personality Disorder (NPD)
Of course, there is nothing wrong with feeling good about yourself. Everyone wants
to see their success and talents noticed by loved ones and others around them. But it
is time for concern when such self-importance gets out of control: where self-love
becomes so strong that there is no compassion for others. This can lead to abuse or
other harmful and unpleasant behaviors, and is how narcissistic personality disorder
becomes a serious problem for those that have it—and for their friends and families.
The History Behind the Disorder
In December 2010, the New York Times reported that the American Psychiatric Association
might drop NPD as a recognized personality disorder in the next edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM), the American Psychiatric Association’s standard
reference for classi cation of mental disorders in the United States. Does this mean that
narcissists can breathe a sigh of relief and say, “See, I told you there was nothing wrong with
me?” Hardly, although they would certainly be the first ones to want to.
The truth is that narcissism and narcissists have been around for far longer than the o cial
diagnosis of NPD, and their immature behaviors create many challenges for themselves and
those around them.
There are no poor narcissists, or at least very few of them. Narcissism seems to be a condition of the privileged. In their
book Personality Disorders in Modern Life, Theodore Millon and Roger Davis state that pathological narcissism was a
condition of the royals and the wealthy. Today, it seems be rampant in powerful and prosperous nations such as the
United States. People in less advantaged nations are too busy just trying to survive to be arrogant and grandiose.
The word “narcissism” comes from the Greek myth of Echo and Narcissus. Echo was a wood
nymph who fell in love with the incredibly beautiful and vain young man, Narcissus. He
ignored her love, and she died of a broken heart. The gods took pity on Echo and were
angered by Narcissus’s pride and vanity. They made him live alone and never know human
love. One day, while bending into a pool for a drink, he fell in love with his own re ection.
He never left it, and died beside the pool.
The British psychologist Havelock Ellis was the rst to use the story of Narcissus in 1898 to
describe pathological self-absorption. Other psychologists soon picked up the terms
“narcissist” and being “narcissistic.” The words came into everyday use after the father of
psychoanalysis Sigmund Freud wrote a paper titled “On Narcissism: An Introduction” in 1914.
Currently the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), and its later revision,
the DSM-IV-TR (Text Revised), which is what mental health professionals use to diagnose mental disorders, lists
narcissistic personality disorder as one of the ten identified personality disorders. As a group, the book describes a
personality disorder as something that involves repeated behavior over a long period of time and leads to trouble at
work, at home, or in social situations.
Different Expressions of NPD
So what is narcissism? As with the boy in the myth, there is an obsession with oneself. But it
is much more than high self-esteem, or being egotistical, conceited, or full of oneself—all of
which could be unattractive attitudes and tough on a relationship. True narcissism involves a
pumped-up ego, as well as an almost maniacal pursuit of gratification, praise, and ambition.
Those with any degree of NPD can be vain, smug, and arrogant, and do appear to have
higher-than-usual self-esteem. But, most of the time, inwardly, narcissists are very insecure,
with little real self-worth. They feed their belief in their own importance from the admiration
of others. This is what is called narcissistic supply—and if that sounds like a drug, for the
narcissist it is. Narcissists are addicted to the need for con rmation of their belief in their
own superiority. Narcissists also typically have a lack of empathy, which means they couldn’t
care less about the feelings of those around them.
There are di erent levels of narcissism. In fact, it could be said that we might all have a
little bit of narcissist in us. It has even been said that some narcissism is necessary just to get
by in today’s world. Maybe a little bit of egotism can be a good thing, but when it comes to
full NPD, behaviors are always destructive.
The psychological criteria for narcissistic personality disorder are:
The narcissist cannot put things in perspective, and situations are blown way out of
proportion.
The narcissist has little or no empathy and cannot identify with the feelings or thoughts
of another person.
The narcissist is preoccupied with his own problems.
The narcissist does not respect authority and has little concern for morals.
The narcissist feels inferior, and will try to be seen as superior.
The narcissist is extremely sensitive to any kind of criticism.
The narcissist is often an exhibitionist and needs sexual admiration.
The narcissist is exploitative, vain, and not self-sufficient.
All cases of NPD show these traits to some degree, but there are some di erent types of
narcissists to watch for.
Since the 1950s there has been a dramatic increase in people with narcissism. As the
numbers of narcissists increased, therapists started noticing some di erences between the
types of narcissism. The rst way that narcissists were divided into di erent types was based
on age. Splitting narcissists into age groups was done because narcissistic tendencies in
children are a learned behavior, and can usually be unlearned. Full-blown NPD is believed to
exist only in adults, and needs to be treated di erently. There have been many other ways
introduced to classify types of narcissistic behavior. The o cial diagnoses of narcissistic
personality disorder did not appear until 1980.
Other than the age distinction, other kinds of narcissists include:
The Craving Narcissist: Despite the typical inflated ego of NPD, craving narcissists are
extremely needy and emotionally clingy, or demanding of love and attention of those
around them.
The Paranoid Narcissist: Paranoid narcissists are the opposite of craving narcissists.
Inwardly the paranoid narcissist is filled with self-loathing and projects that outward,
usually driving people away from them with maniacal jealousy and extreme sensitivity
to criticism.
The Manipulative Narcissist: This is the type of narcissist that actually enjoys
influencing and manipulating others. The manipulative narcissist feeds her need for
power by intimidating others, usually through bullying, lies, and manipulation.
The Phallic Narcissist: Those in this group are almost exclusively males. They are not
only in love with themselves but also with their body image. The phallic narcissist struts
like a rooster. They are aggressive, athletic exhibitionists who enjoy showing off their
muscles, clothes, and other aspects of what they perceive as their superior manhood.
What is narcissistic supply?
Narcissists need a source of “narcissistic supply” from people in their environment just like a baby needs
someone else to bring it food. These love addicts will try to influence their source of supply by every
means possible. The “supply” for narcissists is love, praise, and attention from those around them that fuel their
behaviors.
Grandiosity is the single most signi cant trait of a narcissistic personality. Grandiosity is
not the same as pridefulness or ordinary boasting; it implies self-aggrandizement that has
little or no basis in reality. If a person goes on and on about being the MVP of his college
basketball team at a cocktail party, it may be ill-mannered boasting or conceit, which can be
incredibly annoying and self-serving, but it is not narcissistic if it is true. On the other hand,
if someone made the same type of claim, but was actually a benchwarmer or never even
played on the team, that is being grandiose.
Millon’s Subtypes
Theodore Millon, an American psychotherapist well known for his groundbreaking work in
identifying personality disorders, added these additional subtypes of narcissists:
The Unprincipled Narcissist: This narcissism is characterized by pathological lying and
deliberate deception to obtain narcissistic supply. Millon’s unprincipled narcissist is a con
man, an abuser, deceptive and unscrupulous.
The Amorous Narcissist: The key feature of amorous narcissism is an obsession with
erotica and seduction. A subtype of the manipulative narcissist, the amorous narcissist
uses sex and sex appeal as a tool and a weapon for control and power. He does not
restrict his perceived power of seduction to members of the opposite sex, but believes his
superhuman charisma can influence the same sex as well.
The Compensatory Narcissist: Uses narcissistic supply to compensate for deep and
overwhelming feelings of inadequacy and low self-esteem. According to Millon, the
compensatory narcissist “seeks to create an illusion of superiority and to build up an
image of high self-worth.”
The Elitist Narcissist: Millon’s elitist narcissist has all of the characteristics of the
phallic narcissist, but is not exclusively male.
The Fanatic Narcissist: Fanatic narcissists believe they are gods, but are very paranoid.
They try to fight very poor self-esteem with extreme delusions of grandeur.
No matter what you call it, narcissism remains very di cult to treat. People who su er
from it in any form rarely seek out or enter therapy on their own. After all, not only do they
think that there is nothing wrong with them, they think they are superior to the therapist!
Drug and Alcohol Abuse
Narcissists are dependent by nature. They depend on others to feed their in ated views of
themselves. They crave idolization by others like a physical addiction. It is not surprising
then that often narcissists fall easily into other dependencies, including gambling, compulsive
shopping, workaholism, alcoholism, and drug addiction. The narcissist, like all other addicts,
gets pleasure from the behaviors and actions that feed his narcissistic supply. When that falls
short, he seeks a similar high from other sources such as sex or drugs and alcohol.
Drugs and alcohol can give pleasure and can provide anyone with a way to withdraw from
the pressures of reality. Su erers of NPD will take drugs and drink to support their in ated
self-image and to help them escape when reality does not match up to their world view.
For narcissists, drugs and alcohol became a way to shield themselves from the harsh reality
of a world where they are not the center of the universe; where they have faults, failures,
and limitations just like everyone else. Drugs and alcohol also provide a way for people with
NPD to cut themselves off from what they consider to be the inferior crowd around them.
Compulsory, even risky and dangerous behaviors such as drug and alcohol abuse are also
part of the narcissist’s false view of his superhuman ability to handle them. A narcissistic drug
addict or alcoholic will deny strongly that he has a problem, possibly even more than the
abuser without NPD. Narcissists maintain the grandiose view that they are in control of the
addiction and can quit anytime they want to. They feel they are exempt from conventional
laws regarding the use of illicit substances, as well as immune to the natural laws of
damaging effects on the body.
Narcissists easily fall prey to drug abuse and alcoholism because:
Drugs and alcohol provide feelings of power and well-being.
Drugs and alcohol can make them feel whole.
Taking drugs and abusing alcohol is a totally selfish and self-indulgent act.
Narcissists require a high level of stimulation.
Individuals with NPD prefer drugs that stimulate their inflated sense of self and provide euphoria and feelings of vitality,
and fight feelings of depression and low self-esteem. Cocaine provides all of these, and cocaine abuse is very common
among narcissists.
Narcissists are the emotional equivalent of an alcoholic. As with alcoholics or drug addicts,
their needs are insatiable. There is often a big gap between reality and grandiosity in
narcissists, or the distance between the false image they project and the painful truth. Drug
and alcohol abuse by people with NPD is a way to self-medicate and deal with the pain
caused by this gap.
Narcissists’ addictions serve deep emotional needs. Drug abuse and alcoholism in narcissists
cannot be treated without also treating the underlying NPD.
Eating Disorders
Eating disorders are closely linked to narcissistic tendencies. People su ering from eating
disorders are obsessed with body image. The most common eating disorders are bulimia
(binge eating and purging), anorexia (not eating), and purging (eating very little and forcing
regurgitation), all of which are impulsive, compulsive behaviors. Narcissists are reckless and
impulsive, and can develop eating disorders for the same reasons they become alcoholics or
drug abusers—their desire to exert some power or influence over an aspect of their lives.
A study published in the International Journal of Eating Disorders compared eighty-four women diagnosed with eating
disorders with seventy non-eating-disordered women for core elements of NPD, such as entitlement and grandiosity.
The eating-disordered group scored significantly higher than the other women on the measures of narcissism. The study
concluded that narcissistic traits are particularly relevant in understanding the treatment of eating disorders.
Full-blown NPD is not a common diagnosis in people with eating disorders; however, a
large percentage of patients with eating disorders have narcissistic issues. Consider the
original myth of Narcissus. Narcissus did not actually fall in love with himself, but with his
reflection. He did not know that the unobtainable image he could never reach out and grasp
was himself. This is just like the person with an eating disorder who is in love with an image
in the mirror that she can never hope to obtain.
Relationship Issues
In the narcissist’s worldview, like the death of Narcissus at the side of his own re ection, all
human relationships are doomed from the start. This strong belief usually comes from some
kind of early childhood trauma or negative experience that caused feelings of humiliation,
betrayal, or abandonment.
Even though this belief may have been formed many years ago, to the narcissist any
emotional interaction—any connection that requires an emotional commitment—is bound to
end badly. That means that getting attached to a particular home, a career, a job—even an
idea—is considered by a narcissist to be just as bad as getting attached to people. That is why
the narcissist avoids any kind of intimacy. He may surround himself with people to feed his
narcissistic supply, but he cannot make any real friendships, or truly love, or express any real
feelings of commitment or attachment.
It is extremely di cult to be in any kind of relationship with a narcissist. A narcissist
basically lives in a bubble, surrounded by his own re ection. Try as you might, you cannot
enter that bubble, which leaves you stuck outside, feeling alone, hurt, and frustrated.